Superficial & Deep Fascia of the NECK.pptx

Superficial & Deep
Fascia of Neck
Dr. Rabia Inam Gandapore
Assistant Professor
Head of Department
(Dentistry-BKCD)
B.D.S (SBDC), M.Phil. Anatomy (KMU),
Dip. Implant (Sharjah, Bangkok, ACHERS) , CHPE (KMU),
CHR (KMU), Dip. Arts (Florence, Italy)

LGF (Long Group Format)
SGF (Short Group Format)
LGD (Long Group Discussion, Interactive
discussion with the use of models or diagrams)
SGD (Short Group)
SDL (Self-Directed Learning)
DSL (Directed-Self Learning)
PBL (Problem- Based Learning)
Online Teaching Method
Role Play
Demonstrations
Laboratory
Museum
Library (Computed Assisted Learning or E-
Learning)
Assignments
Video tutorial method
Teaching
Methodology
2

 To help/facilitate/augment the
students about the:
1. Describe skin, superficial
fascia & deep cervical fascia.
2. Discuss attachments of
deep cervical fascia &
pharyngeal spaces.
Goal/Aim
(main objective)
3

At the end of the lecture the student will
able to:
1. Describe skin, superficial fascia &
deep cervical fascia.
2. Discuss attachments of deep
cervical fascia & pharyngeal spaces.
Specific Learning
Objectives
(cognitive)
4

 A student to draw labelled
diagram of the Fascia of Neck
Psychomotor
Objective:
(Guided response)
5

To be able to display a good code of conduct and
moral values in the class.
To cooperate with the teacher and in groups with the
colleagues.
To demonstrate a responsible behavior in the class
and be punctual, regular, attentive and on time in the
class.
To be able to perform well in the class under the
guidance and supervision of the teacher.
Study the topic before entering the class.
Discuss among colleagues the topic under discussion
in SGDs.
Participate in group activities and museum classes
and follow the rules.
Volunteer to participate in psychomotor activities.
Listen to the teacher's instructions carefully and follow
the guidelines.
Ask questions in the class by raising hand and avoid
creating a disturbance.
To be able to submit all assignments on time and get
your sketch logbooks checked.
Affective domain
6

Clinical chair side question: Students
will be asked if they know what is the
function of Fascia
Outline:
Activity 1 The facilitator will explain the
student's Fascia of Neck
Activity 2 The facilitator will ask the
students to make a labeled diagram of the
Fascia of Neck
Activity 3 The facilitator will ask the
students a few Multiple Choice Questions
related to it with flashcards.
Lesson contents
7

 Students assessment: MCQs,
Flashcards, Diagrams labeling.
Learning resources: Langman’s
T.W. Sadler, Laiq Hussain
Siddiqui, Snell Clinical Anatomy,
Netter’s Atlas, BD Chaurasia’s
Human anatomy, Internet
sources links.
Recommendations
8

Introduction
 Neck is region of body that lies between
 Above: lower margin of mandible
 Below: suprasternal notch & upper border of clavicle.
 Cervical part of vertebral column= convex forward &
supports skull, forms bony longitudinal axis of neck.
9

Topic Skin
 Natural lines of cleavage of
skin are constant & run almost
horizontally around neck.
 Clinical Significance:
incision along cleavage line will
heal with narrow scar

Superficial
Fascia
 Superficial fascia of neck forms
thin layer that encloses:
1. Platysma muscle
2. Superficial veins
3. Superficial lymph nodes
4. Cutaneous nerves
11
PSC= Public Service
Commission

1. Platysma Muscle
 Thin, broad, muscular sheet embedded in superficial fascia.
 Located: neck, facial muscles derived from 1st pharyngeal arch
• Origin: Deep fascia over pectoralis major & deltoid
• Insertion: Body of mandible & angle of mouth
• Nerve supply: Facial nerve (cervical branch)
• Action: Depresses mandible & angle of mouth
13

2. Superficial Veins
1. External Jugular Vein (Drains in Subclavian Vein): Posterior auricular +
Posterior division of Retro-mandibular Vein.
Tributaries:
• Posterior auricular vein
• Posterior division of the retromandibular vein
• Posterior external jugular vein: a small vein that drains posterior part of scalp &
neck and joins external jugular vein about halfway along its course
• Anterior Jugular Vein (Jugular Notch): Drains into External Jugular Vein
• Transverse cervical vein
• Suprascapular vein
14

3. Superficial Cervical Lymph Nodes
 Lie along external jugular vein
superficial to sternocleidomastoid
muscle.
 Receive lymph vessels from:
occipital & mastoid lymph nodes,
 Drain: into deep cervical lymph
nodes.
19
Retro-auricular /
Posterior Auricular/
Mastoid lymph Nodes

4. Cutaneous Nerves
Greater Occipital Nerve
Lesser Occipital Nerve
Great Auricular Nerve
Transverse Cutaneous Nerve
Supraclavicular Nerve
Medial Supraclavicular Nerve
Intermediate Supraclavicular Nerve
Lateral Supraclavicular Nerve
20

Deep Cervical
Fascia
Relations , Attachements
and Features
22

Deep Cervical Fascia
 Supports: muscles, vessels & viscera of neck.
 Forms following layers:
1. Investing layer
2. Pretracheal fascia
3. Prevertebral fascia
4. Carotid sheath and Axillary Sheath
5. Buccopharyngeal fascia
6. Pharyngobasilar fascia.
23

1. Investing Layer
Investing Deep Fascia
25

Investing Layer (Investing Deep Fascia)
 Lies: deep to platysma, &
surrounds neck like a collar.
 Forms: roof of posterior
triangle of neck (splits to enclose
trapezius & sternocleidomastoid
muscles)
26
Investing Layer of
Deep Cervical Fascia Carotid
Sheath
Muscular
Pretracheal
Fascia
Visceral
Pretracheal
Fascia
PreVertebral Fascia

Relations
 Superiorly:
a. External occipital protuberance
b. Superior nuchal line
c. Mastoid and styloid processes
d. Stylomandibular ligament
e. External acoustic meatus, tympanic plate
f. Base of the mandible.
g. Parotid gland
h. Submandibular gland.
29

 Inferiorly
1) Spine of scapula
2) Acromion process
3) Clavicle
4) Manubrium (splits 2 layers here)
Supra sternal space
Supra clavicular space
31

 Posteriorly
a. Ligamentum nuchae,
b. Spine of seventh cervical vertebra.
 Anteriorly
Symphysis menti
b. Hyoid bone.
33

Other Features
 Investing layer of deep cervical fascia splits to enclose:
1. Muscles:
 Trapezius
 Sternocleidomastoid
2. Salivary glands:
 Parotid
 Submandibular
3. Spaces:
 Suprasternal space
 Supraclavicular space 34

Suprasternal space or space of Burns
 Contains:
 Sternal heads of right & left sternocleidomastoid muscles
 Jugular venous arch
 Lymph node
 Inter-clavicular ligament.
36

Supraclavicular Space
 Contains:
 External jugular vein
 Supraclavicular nerves
 Cutaneous vessels
 Lymphatic's.
37

 Forms:
1. pulleys to bind tendons of digastric &
omohyoid muscles
2. roof of anterior & posterior triangles.
3. stylomandibular ligament &
parotidomasseteric fascia.
38

2. Pre tracheal
Layer
Pre tracheal Fascia; Thyroid Capsule
41

Pre-tracheal Layer
(Pre-tracheal Fascia; Thyroid Capsule)
Thin layer that is attached above to laryngeal cartilage.
Surrounds thyroid & parathyroid glands, forming a sheath for them (forms
its false capsule so it doesnot fall into the mediastinum) , & encloses
infrahyoid muscles.
Its continuous with buccopharyngeal fascia.
42

Relations
 Superiorly
 Median Plane: Hyoid bone in
 Laterally: Oblique line of thyroid
cartilage
 More laterally: Cricoid cartilage
46

Inferiorly Below thyroid gland
Inferior thyroid veins,
and blends with arch of aorta & fibrous
pericardium.
On Either Side: forms the front of
carotid sheath & fuses with fascia deep
to sternocleidomastoid
47

Other Features
 Posterior layer of thyroid capsule is thick. On either side, it forms a
suspensory ligament for thyroid gland known as ligament of Berry
attached to cricoid cartilage, & may extend to thyroid cartilage. Support
thyroid gland, & do not let it sink into mediastinum.
Function: Fascia provides slippery surface for free movements of trachea
during swallowing.
51

3. Pre-Vertebral
Layer
Pre-Vertebral Fascia; Thyroid Capsule
54

Prevertebral Layer (Prevertebral Fascia)
 Lies in front of prevertebral muscles,
 Forms: floor of posterior triangle of neck
 Extends laterally over first rib into axilla to form axillary sheath.
55

Relations
Superiorly:
Base of skull
Inferiorly:
It extends into superior mediastinum where it splits into
anterior & posterior layers.
1. Anterior layer/alar fascia: blends with
buccopharyngeal fascia
2. Posterior layer: Anterior longitudinal ligament & to
body of 4th thoracic vertebra.
56

 Anteriorly:
• Separated from pharynx &
buccopharyngeal fascia by
retropharyngeal space containing loose
areolar tissue. Lymph nodes lie in
retropharyngeal space
• In lower part of neck, prevertebral &
buccopharyngeal fasciae fuse.
 Laterally:
Deep to trapezius & attached to fascia of
sternocleidomastoid muscle. 58

Other Features
1. Cervical & brachial plexuses lie behind prevertebral fascia. Fascia is
pierced by 4 cutaneous branches of cervical plexus.
2. Laterally forms axillary sheath which extends into axilla. Trunk of
brachial plexus and subclavian artery lies inside it. Subclavian vein and
axillary veins lie outside sheath (Blood moves upward against gravity, so
avoids pooling of blood and allow in dilatation of vein walls)
3. Fascia provides a fixed base for movements of pharynx, oesophagus &
carotid sheaths during movements of neck & swallowing.
59

Carotid Sheath
 Condensation of fibroareolar tissue around main vessels of neck.
Formation:
• Anterior aspect: by pretracheal fascia
• posterior aspect: by prevertebral fascia.
Contents: VNA
• Internal jugular vein
• Vagus nerve
• Common or internal carotid arteries
• CN IX (GP), XI, (SA) XII (HG)nerves 66

Relations
1. Ansa cervicalis lies embedded in anterior
wall of carotid sheath
2. Cervical sympathetic chain (behind which
is prevertebral fascia) lies behind carotid
sheath
3. Sheath is overlapped by anterior border
of sternocleidomastoid, & is fused to layers
of deep cervical fascia.
68

Buccopharyngeal Fascia
• This fascia covers all constrictor muscles externally & extends onto
superficial aspect of buccinator muscle
• Retropharyngeal space lies posterior to buccopharyngeal fascia.
71

Pharyngobasilar Fascia
 Fascia is thickened between upper border of
superior constrictor muscle & base of skull.
 Lies deep to pharyngeal muscles
74

Retropharyngeal Space
 Situation: Dead space behind pharynx.
 Function: Acts as a bursa for expansion of pharynx during deglutition
 Boundaries:
• Anterior: Buccopharyngeal fascia
• Posterior: Prevertebral fascia. The two get fused.
• Sides: Carotid sheath
• Superior: Base of skull
• Inferior: Open and continuous with superior mediastinum.
 Contents: Retropharyngeal lymph nodes, pharyngeal plexus of vessels and
nerves, loose areolar tissue.
76

Lateral Pharyngeal
Space
 Situation: Side of pharynx
 Boundaries:
• Medial: Pharynx
• Posterolateral: Parotid gland
• Anterolateral: Medial pterygoid
• Posterior: Carotid sheath
Contents: Branches of maxillary
artery Fibro-fatty tissue
78

Clinical
Relevance
Superficial Fascia
81

Platysma Tone & Neck Incisions
In lacerations or surgical
incisions in neck, its crucial that
subcutaneous layer with
platysma be carefully sutured,
because tone of platysma can
pull on scar tissue, resulting in
broad, unsightly scars.

Platysma Innervation
& Mouth Distortion
 Cervical branch of facial nerve
innervates platysma muscle.
Origin: lower end of parotid gland &
travels forward to platysma; it crosses
lower border of mandible to supply
depressor anguli oris muscle.
 Skin lacerations over mandible or upper
part of neck that affects platysma may
distort shape of the mouth.
83

External Jugular Vein Visibility
 Women & Children: External jugular vein
is less obvious because subcutaneous
tissue is thicker than in adult men.
 In obese: vein may be difficult to identify
even while holding breath, which impedes
venous return to the right side of heart &
distends vein.
 Superficial veins of neck: tend to be
enlarged & often tortuous in professional
singers because of prolonged periods of
raised intrathoracic pressure. 84

External Jugular Vein as a Venous
Manometer
 Serves as useful venous
manometer.
 Normally, when patient is
lying at a horizontal angle of
30°, level of blood in
external jugular veins
reaches about one third of
way up the neck.
As patient sits up, blood
level falls until its no longer
visible behind clavicle. 85
Fluid Status

External Jugular
Vein Catheterization
Used for catheterization, but presence of valves
or tortuosity make passage of catheter difficult.
Because right external jugular vein is in most
direct line with superior vena cava, it is one most
commonly used.
The vein is catheterized about halfway between
level of cricoid cartilage & clavicle.
The passage of catheter should be performed
during inspiration when valves are open.
86

Clinical
Relevance
Deep Fascia
88

Clinical Significance of Deep Fascia
 forms distinct sheets called investing, paratracheal & prevertebral layers & easily
recognizable by surgeon during operation.
• Fascial Spaces
 Loose connective tissue forms potential spaces i.e visceral, retropharyngeal,
submandibular & masticatory spaces
 Organisms originating in mouth, teeth, pharynx & esophagus can spread among
fascial planes & spaces
 Fascia determines direction of spread of infection & path taken by pus.
 Blood, pus, or air in retropharyngeal space to spread downward into superior
mediastinum of thorax.

Acute Infection of Neck Fascial
Spaces
• Dental infections commonly involve
lower molar teeth & infection spreads
medially from mandible into
submandibular & masticatory spaces
and pushes tongue forward & upward.
Further spread downward may involve
the visceral space & lead to edema of
vocal cords & airway obstruction.
• Ludwig angina Commonly
secondary to dental infection, acute
infection of submandibular fascial
space
90

Chronic Infection of Neck Fascial
Spaces
Tuberculosis infection of deep cervical
lymph nodes result in liquefaction &
destruction of one or more of nodes.
 Investing layer of deep fascia at first limits
pus.
Later, this becomes eroded at one point, &
pus passes into superficial fascia.
A dumbbell or collar-stud abscess is now
present.
 Clinician is aware of superficial abscess
but must not forget existence of deeply
placed abscess. 93

Superficial & Deep Fascia of the NECK.pptx

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Superficial & Deep Fascia of the NECK.pptx